PERSONALITY DISORDERS

If the person develops a positive self-concept, body image, and sense of self-worth, and is able to
relate to others openly and honestly she or he is said to have characteristics of a healthy personality.
Should the person develop inflexible, maladaptive behaviors that interfere with social or occupational
functioning, the person exhibits signs and symptoms of a personality disorder.

A personality disorder is described as a non-psychotic illness characterized by maladaptive behaviors,

which the person uses to fulfill his or her needs and bring satisfaction to him or herself.

Cluster A Disorders
People who exhibit paranoid, schizoid and schizotypal personality disorders are considered “odd” or
eccentric in the vernacular and are grouped in the first cluster.

Cluster B Disorders
These are people with antisocial, borderline, histrionic, and narcissistic personality disorders. They are
considered to be emotional, erratic, or dramatic in behavior.

Cluster C Disorders
Anxious or fearful behaviors are often present in the third cluster, which includes obsessive-compulsive,
dependent, and avoidant personality disorders.

Personality Disorders, Not Otherwise Specified (NOS)

This category is reserved for those disorders that do not fit into any of the three clusters

CLUSTER A DISORDERS: ODD, ECCENTRIC BEHAVIOR

Paranoid Personality Disorder
− Prevalence is 0.5% - 2.5% of
the general population
− Seen more frequently in men
 Chronic hostility projected towards others
 Unwarrantedly suspicious and mistrusts people
 Suspect attempts to trick or harm him/her
 Questions loyalty of others
 Displays pathological jealousy
 Observes the environment for any signs of threat
 Displays secretiveness
 Hypersensitive
 Displays excessive feelings of self-importance
 Appears to be unemotional
 Lacks a sense of humor, and ability to relax
 Poor interpersonal relationships, especially when relating to
authority figures or co-workers – lifelong interpersonal, marital and
occupational problems.

 No desire for social involvement

Schizoid Personality Disorder
− “introvert” or “loner”
− Prevalence is 7.5% of the
general population
− Males are twice as likely to
develop this type of
personality disorder
 Pervasive pattern of detachment from social relationships
 Restricted range of emotional expression in interpersonal settings
 Avoids close relationships
 Chooses solitary activities
 Has little interest in sexual experiences
 Does not take pleasure in activities
 Lacks close friends or confidants
 Appears indifferent to praise or criticism
 Exhibits emotional coldness such as detachment or flattened effect

Schizotypal Personality Disorder
− Symptoms are similar but not
severe enough to meet the
criteria for schizophrenia
− Approximately 3% if the
population but the sex ratio is
unknown
CLUSTER B DISORDERS: EMOTIONAL, ERRATIC, OR DRAMATIC BEHAVIOR
Antisocial Personality Disorder
− Sociopathic disorder
− Psychopathic disorder
− Semantic disorder
− Between ages 15 and 40
years old
− Diagnosis of conduct
disorder is given to clients
who exhibit clinical
symptoms before age 18
− 80% - 90% of all crime is
commited by individuals with
antisocial personality
disorder
− More prevalent in men (3%)
than in women (1%)
 Attention is usually focused on objects rather than people
 Exhibits a disturbance in thought process referred to as magical
thinking, superstitiousness, or telepathy (sixth sense)
 Experiences ideas of reference
 Limits social contacts
 Described perceptual disturbance such as illusions or
depersonalization
 Demonstrates peculiarity in speech but no loosening of association
 Appears aloof or cold because they exhibit an inappropriate affect.
 Paranoid ideation
 Odd or eccentric behavior or appearance
 Excessive social anxiety
 Conduct Disorder: truancy, misbehaviors at school, delinquency,
substance abuse, vandalism, cruelty and disobedience.
 Lack of remorse or indifference to people whom one has hurt or
mistreated, or from whom one has stolen
 Expects immediate gratification
 Fails to accept social norms
 Impulsive
 Consistent irresponsibility
 Aggressive behavior
 Lack of respect for social norms
 Repeated lying
 Reckless behavior that disregards the safety of others

Borderline Personality Disorder
− Latent, ambulatory and
abortive schizophrenics
− Symptoms fall between
moderate neurosis and frank
psychosis
− Occurs in all races
− Affects 1% to 2% of the
population
− Prevalent in women (female-
to-male ratios as high as 4:1)
− Presents in late adolescence
Histrionic Personality Disorder
− Theatrical or overly dramatic
behavior
− More frequently in women
− Approximately 2% to 3% of
the general population
Narcissistic Personality Disorder
− Exaggerated or grandiose
sense of self importance
− Symptoms usually develop
early childhood
− Prevalence is less than 1%
and occurs predominantly in
men
− Risk for suicide is higher
compared with individuals
with other personality
disorders
CLUSTER C DISORDERS: ANXIOUS, FEARFUL BEHAVIOR
 Almost always appear to be in a state of crisis
 Disillusioned and experiences rage, fear of abandonment and
depression
 Biologic defect of the amygdale (area of the brain that regulates
emotion) causing severe mood swings and abnormal behavior
 Impulsive, unpredictable behavior related to gambling, shoplifting,
sex and substance abuse
 Inappropriate intense anger contributing to unstable intense
interpersonal relationships
 Unstable affect reflecting depression, dysphoria or anxiety
 Disturbance in self-concept, including gender identity
 Unable to control emotions
 Paranoid ideation, severe dissociation, masochism, frantic efforts to
avoid real or imagined abandonment and suicidal ideation.
 Reports feeling empty, lonely, unable to experience pleasure and
unable to maintain employment
 Self-mutilating behavior
 Inappropriate sexually seductive or provocative behavior
 Self-dramatization and emotional exaggeration to draw attention to
self.
 Style of speech is excessively impressionistic
 Lacking in detail as the client exhibits labile emotions
 Easily influenced by others or by circumstances
 Considers relationships to be more intimate than they really are
 Creative and imaginative
 Exhibits dependency and helplessness
 Handles feelings of criticism freely
 Preoccupied with fantasies of unlimited success, power and beauty
 Believes he/she is unique and should associate with other high-
status individuals
 Displays arrogance
 Displays sense of entitlement
 Lack of empathy as he or she exploits other
 Values beauty, strength and youthful attributes
 Aging is handled poorly
 Prone to extreme mood swings

Obsessive-Compulsive
Personality Disorder
− Prevalence is unknown
− Most common in men
− Diagnosed most often in first-
born children
− More frequently in first-
degree biologic relatives of
clients with the disorder than
in the general population
Dependent Personality Disorder
− Also referred to as passive-
dependent personality
disorder
− People with recurrent or
chronic illness in childhood
are most prone
− More frequently in women
Avoidant Personality Disorder
− Prevalent in 1% to 10% of
the general population and in
approximately 10% of clients
seen in mental health clinics
PERSONALITY DISORDER, NOT OTHERWISE SPECIFIED
Passive-Aggressive Personality  Exhibits covert obstructionism through manipulative behavior,
Disorder procrastination, stubbornness and inefficiency due to dependency
− Also referred to as
negativistic personality
disorder
Depressive Personality Disorder
− Exhibits life-long depressive
symptoms
 Preoccupied with rules and regulations
 Overly concerned with organizational and trivial detail
 Excessively devoted to their work and productivity
 Preoccupied with details, lists, and rules to the extent that the major
point of the activity is lost
 Perfectionism interferes with task completion
 Overly conscientious, scrupulous, inflexible and reluctant to
delegate duties to others
 Excessive devotion to work and productivity
 Commonly experiences depression
 Thoughtful and considerate, faithful and devoted, agreeable and
cooperative; however
 Lacks self confidence
 Unable to function in an independent role
 Allows others to become responsible for their lives because they
experience difficulty making everyday decisions, disagreeing with
others and initiating projects or doing things independently
 Client goes though excessive lengths to obtain nurturance and
support from others
 Unrealistically preoccupied with fears of being left alone to care for
himself/herself
 Highly sensitive to rejection, criticism, humiliation, disapproval,
shame, appearing devastated by the slightest amount of
disapproval
 Extreme sensitivity interferes with participation in occupational
activities, development of interpersonal relationships and ability to
take personal risks or engage in new activities
 Client views him or herself as socially inept, personally unappealing
or inferior to others
 Experiences difficulty in adjusting to loose, unpredictable
environment, especially those requiring social activities or public
appearances
 Feelings of anxiety, anger and depression
 Social phobia may occur when withdrawal and hypersensitivity
persist over time
upon others
 Lacks self-confidence and are pessimistic about the future
 Chronically unhappy
 Exhibits low self-esteem
 Self-critical and denigrating about their work, themselves and their
relationships
  Exhibits poor posture, raspy hoarse voice, flat or blunted affect and
psychomotor retardation

SCREENING AND ASSESSMENT TOOLS

Millon Clinical Multiaxial Inventory (MCMI-III)

− Designed to help assess both Axis I disorders (clinical disorders and conditions such as anxiety
and depression) and Axis II disorders (personality disorders and mental retardation)
− Assists in the diagnosis and development of a treatment approach that takes into account the
clients personality style and coping behavior

Structured Interview for DSM-IV Personality (SIDP-IV)

− Uses questions to examine behavior and personality traits from the clients perspectives
− Helps distinguish lifelong behavior from temporary states that can result from an episodic
psychiatric disorder
− Assists in the diagnosis and development of a treatment approach to improve the clients quality
of life.

MANAGING SYMPTOMS OF CLIENTS WITH PERSONALITY DISORDERS

For clients with disturbance in cognition

Reinforce reality if the client verbalizes illusions or feelings of depersonalization. Help the client
select someone he or she trusts to minimize suspicious or delusional thoughts.
Encourage the client to validate perceptions before taking action that may precipitate difficulties.
Explore with the client present maladaptive coping mechanisms and the purpose they serve.
Explore alternate coping mechanisms to reduce stress.
Assist the client to develop insight regarding the purpose of nursing interventions.

For clients with disturbance in affect

Encourage the client to verbalize feelings of anger, hostility, worthlessness, or hopelessness.
Give attention and support when the client expresses feelings honestly and openly.
Encourage the client to share his or her feelings with others.
Provide a safe environment if the client expresses suicidal ideation or exhibits self-mutilation
behavior.

For the clients with disturbance in interpersonal functioning

Explore reasons the client has difficulty establishing interpersonal relationships.
Explore the client’s self-concept and self-esteem.
Explore the client’s perception of how others view him or her.
Provide positive feedback regarding your observations of the client’s strengths.
Encourage the client to socialize with at least one person daily.
For the clients who exhibits dysfunctional behavior indicative of poor impulse control
State limits and behavior expected from the client.
Enforce all limits without apologizing.
Be direct, confronting the client when limits are not observed.
Discuss consequences of client’s failure to observe limits.
Discuss behavior with the client in a nonjudgmental manner.

DRUGS USED FOR PERSONALITY DISORDERS

Antipsychotics – haloperidol (Haldol); clanzapine (Zyprexa)

− For paranoia, psychoses, aggression and post traumatic stress

Anticonvulsants – carbamazepine (Tegretol); valproate (Depakote)

− For aggression, impulsivity, mood disorders and suicidality

Antidepressants – venlafaxine (Effexor)

− For depression, anxiety, panic attacks

Antianxiety Agents – clomipramine (Anafranil); clonazepam (Klonopin)

REFERENCE: BASIC CONCEPTS OF PSYCHIATRIC-MENTAL HEALTH NURSING pp. 408-425